Food allergies have been rising in recent years, and the result can be measured not just in patient morbidity but in financial costs to the healthcare system. In a recent white paper (PDF), FAIR Health analyzed data from our database of billions of private healthcare claims to examine both trends and costs related to food allergy and anaphylactic food reaction, a severe, potentially fatal allergic reaction.
Our analysis revealed that costs for anaphylactic food reactions have been climbing. Laboratory services accounted for the greatest percentage increase in the charges. Although laboratory services associated with diagnoses of anaphylactic food reaction increased 871% in utilization from 2007 to 2016, charges for those services grew 5,390%. The next greatest increase in charges was for emergency room services, which increased by 1,387%, even though utilization of emergency room services grew by only 161%.
Tracking variations in average charges and allowed amounts
In 2016, average charges and allowed amounts per patient varied according to food allergy. On the lowest side, average charges with diagnoses for allergy not elsewhere classified (NEC) amounted to $186.34, in contrast to the high of $1,043.89 for milk product allergy. Regarding average allowed amounts, food additives allergy ranked lowest at $61.28, while milk product allergy was the highest with $414.66. In 2016, the food allergy with the highest average costs and services per patient was milk product allergy, generally associated with the youngest patients (infants and toddlers) and with prescription formulas.
We discerned a different pattern when we analyzed average costs per patient diagnosed with anaphylactic food reaction in 2016. There was less variation in charges (ranging from a low of $276.31 to a high of $820.52) and in allowed amounts (registering from $145.49 to $272.27). The highest average costs (both charges and allowed amounts) were for anaphylactic reaction to fish, possibly because it is relatively uncommon, accounting for just 2% of the anaphylactic food reaction claim lines between 2007 and 2016. (“Claim lines” are the individual procedures or services listed on an insurance claim as determined by a provider.) Also, since fish products can show up in unexpected places, such as barbecue sauce, Caesar salad and Worcestershire sauce, it may require extensive testing to discover the anaphylactic reaction’s trigger.
Geographic and demographic factors
Geographic and demographic factors are likely to have an impact on where and with which population food allergy costs are greatest. Some states have a higher percentage than others of claim lines with food allergy diagnoses compared to all of a state’s medical claim lines. In 2016, the top five states and the District of Columbia with food allergy claim lines were (in order from highest percent) North Carolina, North Dakota, New Jersey, Washington, D.C., and Connecticut. But, even though North Carolina had the nation’s highest percentage of claim lines with food allergy diagnoses in 2016, it reported a relatively low percentage of claim lines with food allergy diagnoses in 2009.
Food allergy affects both urban and rural areas. In 2016, 60% of claim lines with food allergy diagnoses occurred in urban areas, with 40% in rural zones. Yet from 2007 to 2016, rural claim lines with food allergy diagnoses increased by 110%, while urban claim lines rose only by 70%.
Places of service and procedure code categories
Even though anaphylaxis is typically regarded as a medical emergency, from 2007 to 2016, 70% of services provided to patients diagnosed with anaphylactic food reaction were rendered in an office, while only 2% occurred in an emergency room. And, although 70% of services were rendered in offices, only 51% of the charges were attributable to office-based services, which suggests that the office was not as costly a venue as other places of service.
The place of service with the highest growth in this period was the outpatient facility setting, which increased in utilization by 1,070%. Laboratory services registered the next highest increase at 871%, while inpatient utilization rose by 229%.
From 2007 to 2016, the most common procedure code category associated with food allergy diagnoses was office or outpatient services to an established patient, accounting for 21% of procedures. At 16%, immunology services were the second most common procedure code category. Allergy testing was the third most common, at 10%.
A burden on the system
At this point, we do not know the precise reason for the pronounced rise in food allergy. But we know it is a public health concern, and in addition, it is an increasing financial burden. More research is necessary to understand the costs and to determine how they can be controlled.
The white paper has been made possible in part with the generous funding of Food Allergy Research & Education.
Robin Gelburd, J.D., is the president of FAIR Health, a national, independent nonprofit with the mission of bringing transparency to healthcare costs and insurance reimbursement. FAIR Health oversees the nation’s largest repository of private healthcare claims data, comprising more than 23 billion billed medical and dental charges that reflect the claims experience of more than 150 million privately insured Americans.